New ER director says transition going well

The board of the Haywood Regional Medical Center heard a glowing report last week on how the hospital’s emergency department is going following an abrupt transition four months ago.

At the end of December, the hospital board terminated the contract of a long-time team of doctors who ran the ER and hired a national physician staffing company instead. Dr. DeWayne Butcher, the interim director of the ER for the new company, Phoenix, gave the hospital an update on what’s happened in the ER over the past four months. Butcher said six full-time doctors have been recruited so far. Some will be coming on board this month, with all six in place by July.

In the meantime, more than 20 out-of-town doctors have been rotating through the ER. They come to Haywood for a few days at a stretch. Butcher said they were selective about which doctors they recruited for these revolving shifts. Butcher said all doctors went through a two-hour training session to get acquainted with the department before pulling their first shift in the ER. Most are certified specifically in emergency medicine, he said.

The six full-time ER doctors who’ve been recruited aren’t going to be enough, however, Butcher said.

“There will still need to be some additional part-time coverage,” Butcher said. Butcher said a few of the rotating doctors will likely stay in the rotation and occasionally pull shifts.

The old ER doctors, called Haywood Emergency Physicians, had more doctors and provided more hours of care in the day than Phoenix is. Haywood Emergency Physicians had 10 full-time doctors when fully staffed.

Butcher also commented on the relationship between the new doctors and the ER nurses. Butcher said while the environment was “very heated” when Phoenix first came, the doctor-nurse rapport is now OK.

“I have consistently asked the nurses’ opinions and not once have I gotten a negative response,” Butcher said. “They said, ‘we like everyone of the new doctors.’”

His report contradicted an interview with five ER nurses printed in The Smoky Mountain News last week who said they liked the old ER doctors better and have issues with how the ER is being run now.

One thing that has taken a step backwards since the new ER doctors came on board is computerized patient records, according to nurses. Rather than recording information about a patient into the computer system as the old doctors did, the new doctors write prescriptions by hand and use paper charts. Nurses have complained that this slows them down, makes it more difficult to know the status of a patient, and is more difficult for doctors doing follow-up visits to know what went on with a patient in the ER.

Butcher said the new ER doctors are working to reverse this. Butcher said the new doctors soon will start entering their prescriptions into the computer so nurses, pharmacists and other doctors will know what a patient has been prescribed. Butcher said the new doctors will be trained to enter patient observations and diagnosis into the computer system as well.

This will all be done on a new computer system Haywood Regional has been trying to launch since the new ER opened more than two years ago. The new computer system, called Meditech, was a source of controversy between the hospital and old ER doctors, who claimed it didn’t work well.

Butcher said the new doctors have put up “no resistance” to using Meditech, although they are not using it yet. Butcher said he is looking for another hospital that uses Meditech for recording patient data so the ER doctors can visit it and see a demonstration. That was long on the wish list of the old ER doctors. The hospital board also wanted to find somewhere Meditech could be viewed in action, but it never happened.

Meanwhile, a system has been implemented to speed up patients being seen in the ER. In the past, moving patients from the ER to the main hospital has taken too long. Patients being admitted from the ER to the main hospital sometimes lingered in ER beds for a couple of hours before being transferred.

The old ER doctors attempted to address this issue repeatedly with hospital administration and asked the hospital to create a holding area to speed up the transfer of patients so the ER beds could be freed up for ER patients. The hospital has addressed this with the new ER doctors and developed a new system to speed the transfer of patients.

“When a emergency doctor decides a patient is to be admitted, they are actually admitted,” said hospital CEO David Rice.

It’s not the only issue the old ER doctors complained about that has been addressed under the new team. The hospital has agreed to open three extra rooms in the ER for the new doctors. The old doctors wanted to open these extra rooms as well, but the nurses objected, claiming they needed more staff if they were going to handle more rooms. The hospital didn’t want to hire more nurses so the rooms remained closed. Now, however, a deal has been struck to open the extra rooms during peak volumes for patients that need minimal oversight.

Butcher said there has been a lot of progress in the new ER in the past four months.